The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: a modelling study

Abstract

Background: Tuberculosis (TB) is preventable and curable but eliminating it has proven challenging. Safe and effective TB vaccines that can rapidly reduce disease burden are essential for achieving TB elimination. We assessed future costs, cost-savings, and cost-effectiveness of introducing novel TB vaccines in low- and middle-income countries (LMICs) for a range of product characteristics and delivery strategies. Methods: We developed a system of epidemiological and economic models, calibrated to demographic, epidemiological, and health service data in 105 LMICs. For each country, we assessed the likely future course of TB-related outcomes under several vaccine introduction scenarios, compared to a 'no-new-vaccine' counterfactual. We estimated the incremental impact of vaccine introduction for a range of health and economic outcomes. In the base-case, we assumed a vaccine price of $4.60, and used a 1x per-capita GDP cost-effectiveness threshold (both varied in sensitivity analyses). Findings: Vaccine introduction was estimated to require substantial near-term resources, offset by future cost-savings from averted TB burden. From a health system perspective, vaccination was cost-effective in 65 of 105 LMICs. From a societal perspective (including productivity gains and averted patient costs), vaccination was projected to be cost-effective in 75 of 105 LMICs and cost-saving in 57 of 105 LMICs, including 96% of countries with higher TB burden. When considering the monetized value of health gains, we estimated that introduction of an adolescent/adult vaccine could produce $258-447 billion in economic benefits by 2050. Interpretation: TB vaccination would be highly impactful and cost-effective in most LMICs.

The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: A modeling study

“…For ART costs, direct non-medical costs (travel, accommodation, food, nutritional supplements) to the patient, and productivity costs (income loss experienced by patients during TB care), we derived unit costs by extrapolating estimates reported by the Global Health Cost Consortium [ 19 ] (sample size = 39) and WHO patient cost surveys (sample size = 20) [ 20 , 21 ] with meta-regression models for the respective outcomes specified as generalized linear regression models (GLMs), assuming a Gamma distributed outcome, a log link function, and gross domestic product (GDP) per capita as the predictor [ 22 ]. The previous unit costs were inflated to 2020 values in local currency using the country consumer price index [ 23 ] and converted to 2020 US dollars using market exchange rates [ 24 ].…”

The potential impact of novel tuberculosis vaccine introduction on economic growth in low- and middle-income countries

“…Detailed methods and outcomes of these models are described elsewhere. 6,9 We used the results of these analyses to generate inputs for an existing macroeconomic model, which we used to translate changes in disease-related mortality, morbidity, and health service utilization into projected macroeconomic outcomes.…”

“…In the base-case analysis, in addition to vaccination program costs, we included costs from the societal perspective for direct medical costs TB/HIV treatment (both government- and patient-level costs), and patient-level direct non-medical costs (additional details on cost assumptions are described elsewhere 9 ). For all unit cost inputs related to service provision, we subtracted the share contributed by international donors, to obtain unit costs reflecting the contribution of domestic resources to service provision.…”

“…Studies considering the global impact of TB vaccine reduction have estimated up to 40–50 million TB cases could be averted by an effective vaccine by 2050, 6,7 as well as substantial reductions in TB drug resistance. 8 Other studies have placed a monetary value on the health benefits generated by TB vaccine introduction, either by reference to the opportunity cost of healthcare spending 9 , or individual willingness-to-pay to reduce health risks. 10 In addition to these health impacts, studies have quantified the consequences of TB vaccines in terms of reduced income losses due to averted TB, 7,11 and reductions in catastrophic health expenditures for TB affected households 11 .…”